Three Ways Digital Pathology Optimizes Multidisciplinary Team Meetings
By Alyn Cratchley, MBChB, Consultant Histopathologist, Leeds Teaching Hospital, UK
Digital pathology has been integral to my practice from my earliest training in histopathology for breast and liver cancers at Leeds Teaching Hospital. At the early stages of my pathology training, I was aware of some of the benefits of digital pathology but was skeptical as to how well it was actually going to work in practice; I have since become a digital convert due to the benefits this provides to my clinical practice.
Now, 95 percent of my work is conducted digitally and, for the last 2 ½ years, I have served as the clinical lead for digital pathology in Leeds Teaching Hospital working with the National Pathology Imaging Cooperative (NPIC). In our department, this role includes responsibility for:
- supporting the department-wide integration and adoption of digital pathology.
- managing and aiding the testing of infrastructure changes, such as upgrading scanners and transitioning from our original in-house digital system to a vendor-built PACS.
- coordinating consultant digital pathology validation within the department.
- developing a mechanism for assembling teaching sets within our PACS system.
- serving as the point of contact within my department to answer questions and address any problems.
- the integration of digital pathology into our institution’s Multidisciplinary Team Meetings (MDTs, also referred to as Tumor Boards).
- liaising with other regional clinical leads to aid and support the roll out to other hospitals within the region as part of NPIC.
The positive impact of digital on our contributions to MDTs is notable. For context, it has been more than 50 years since organizations involved in cancer care began holding MDTs. From the outset, pathologists have been essential contributors to these meetings and our role continues to expand as the number and scope of MDTs proliferate in tandem with rising cancer rates worldwide. In 2022, the Royal College of Pathologists issued updated MDT Best Practice Recommendations, noting “…MDTs provide more sophisticated and personalised treatments to a higher volume of patients, with increasing complexity.” I support the Royal College’s efforts to optimize pathology’s involvement in MDTs, which are valuable, but the preparation involved can be time-consuming and logistically challenging. At Leeds, our team has found that practicing digital pathology has enhanced our impact on MDTs in three key ways: improving quality, streamlining workflow, and facilitating patient-centered care.
#1: Raising the Bar on Quality
Quality is paramount in pathology. Digital pathology improves the quality of our work in numerous ways. Digital pathology creates high-quality images that are easily and efficiently captured, stored, retrieved, viewed and shared. It facilitates preparation in advance of an MDT meeting and can enhance the quality of discussion and decision-making by enabling immediate access to clinical data, both up-to-the-minute and archived during an MDT.
For example, a number of our hepatology clinicians have told me they prefer it when I present digital images in the MDT because of the clarity of images and how well I can demonstrate images in real-time, highlighting key features. During the COVID-19-induced lockdowns, Leeds was compelled to shift to ‘virtual MDTs’ conducted over video conference. A positive—and unexpected—outcome of doing so was clinicians advising they could see areas of interest better on their computer screens than they had been able to on a big screen at the front of the room during an in-person MDT meeting. This improved view enabled clinicians to have a greater understanding of my remarks and pinpoint the features the pathologist was trying to highlight. The ‘virtual MDTs’ improved the process so much that clinicians have requested we keep some of our meetings virtual rather than reverting back to face-to-face meetings.
#2: Streamlining MDT Preparation for the Pathology Team and Clinicians
Digital pathology streamlines the MDT preparation workflow for both administrative team members and pathologists, making it easier to find key slides, consult with colleagues, highlight specific slides, and annotate particular areas of diagnostic significance to present during the meeting.
From an administrative perspective, adopting digital pathology reduces the time spent collating the list of cases because the MDT’s secretary can compile a single list in one go, with confidence that this will automatically be updated with any changes to reports, and as such will remain accurate and complete. There is no longer a need for the secretary to repeatedly check all cases on the MDT list to find out whether a report needs reprinting due to being authorized since the original time the MDT was compiled, or if any cases have had a supplementary report added, making this aspect of administration preparation quicker and easier. Digital pathology also eliminates the time the secretary spends collecting and returning glass slides, which is typically a significant time commitment.
From my perspective as a consultant pathologist, I value the workflow efficiencies that result in substantial time savings. For example, when reviewing cases in advance of an MDT, I find having prior cases accessible at the click of a button saves a significant amount of time and facilitates the completion of the report in one sitting. The alternative is to request priors from the archive, which can take hours or days depending on whether they are housed locally on site (for recent cases) or remotely in long-term storage (for older cases), potentially delaying the final report.
#3: Enabling Patient-Centered Care
Digital pathology enables clinicians to make informed recommendations more quickly – a real win for patients, whom we know are eagerly, and often anxiously, awaiting a confirmed diagnosis and treatment plan to be confirmed at the MDT.
Simply put, the easy access to recent and archived information enabled by digital pathology contributes to improved patient management in a way that is not possible with glass slides. This will become even more evident with the expanding roll out of digital pathology across our region as we will be able to access cases which have been reported elsewhere, but required for centralized review as part of a specialist MDT. Personally, I value the more comprehensive perspective on cases and appreciate that digital pathology mitigates a myriad of factors which typically add weeks to the finalization and implementation of a patient treatment plan, such as:
- Cases failing to be discussed at the MDT because the glass slides cannot be located in the department, or not arriving from external trusts for review.
- Cases requiring re-discussion in a subsequent MDT as they were not complete at the time of the meeting being prepared (with digital pathology, the report available via the PACS will be the up-to-date version, as it is automatically updated at the time of case authorization, even if signed out by a colleague during the meeting).
- Additional questions raised at MDT necessitating deferral to the following meeting when using glass slides, rather than being able to complete the discussion with a quick review of the digital slide during the meeting.
In our breast cancer MDT, for example, we have found it incredibly beneficial to have real-time access to original biopsy histology on prior cases at the click of a button to compare with resection histology. During an MDT meeting, I can now pull up a previous biopsy or report in real-time. No longer do I (or the MDT secretary) need advance notice to hunt down the glass slides, as the images are a few clicks away.
These types of wins motivate pathologists to explore the potential of digital pathology for patients, for pathologists, and for our profession. I count myself lucky to be among the first generation of pathologists ‘born digital’ and am excited for others to realize the opportunities digital pathology offers.
National Pathology Imaging Co-operative, NPIC (Project no. 104687) supported by a £50m investment from the Data
to Early Diagnosis and Precision Medicine challenge, managed and delivered by UK Research and Innovation (UKRI)
Bio: Alyn Cratchley
Alyn Cratchley is a consultant pathologist based at Leeds Teaching Hospitals NHS Trust, specialising in Liver (including transplant) and Breast Pathology. She is also the Clinical Lead for digital pathology deployment as part of the National Pathology Imaging Cooperative (NPIC). She developed an interest in pathology after completing a foundation training post in Stoke on Trent, before commencing her formal histopathology training during 2014 in the Yorkshire and Humber deanery. After completion of training, Alyn accepted a consultant post at Leeds in 2019. During her training, Leeds were integrating and adopting digital pathology within clinical practice, which has led to her involvement from an early stage within its implementation. Recently, in her role as Clinical Lead, she has overseen the transition to a new digital PACS, and has presented work on the utilization of digital pathology in the creation of teaching sets at the Digital Pathology Association’s Pathology Visions 2022 conference held in Las Vegas, which was awarded the ‘Best Education’ Poster prize.